Coronavirus Vaccine Advocacy Needs to Start Now
Experts should take note of the successes of childhood vaccination advocates
Over the last few months, scientists have been racing at breakneck speed to develop a vaccine that will protect against the novel coronavirus that causes Covid-19, which has ground daily life in many places around the world to a halt.
But another group with very different goals has also been working tirelessly during this time. From the viral Plandemic documentary to the Washington D.C. press conference held by a group of mask-skeptic, pro-hydroxychloroquine physicians, conspiracists have sought to undermine the advice dispensed by health authorities and disrupt the fundamental narrative about the pandemic and public safety.
At the eye of this conspiratorial hurricane is the potential coronavirus vaccine. Medical conspiracists and anti-vaccine advocates have posited that any vaccine will simply be another project to line Big Pharma’s coffers, a cover for tech billionaires to insert microchips into people, or anything in between.
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And their stories are catching on. While the majority of Americans say they will get the Covid-19 vaccine, a CNN poll conducted in June found that 33% of people surveyed said they would refuse a coronavirus vaccine, even if it were low cost and widely available. Some doctors and researchers, including Anthony Fauci, MD, the director of the National Institute of Allergy and Infectious Diseases, worry that these figures indicate it might be harder to reach the herd immunity necessary for society to work its way back toward some semblance of normality.
But there is an opportunity here: An Associated Press-NORC poll from the spring concluded that 31% of people aren’t sure whether they’d get the vaccine. These people are “vaccine-hesitant:” they’re not as fanatical as the anti-vaccine contingent, but they have concerns, perhaps over efficacy and toxicity, and they aren’t sure who to trust on the issue.
While medical conspiracy theorists thrive in an informational vacuum, scientists and proponents of evidence-based medicine prefer to have all the facts at their disposal before they weigh in. However, if they wait too long, they risk losing the attention of the vaccine-hesitant. So in the lead-up to a coronavirus vaccine, the U.S. should be looking to pro-vaccine advocates and educators who have experience dialoguing with vaccine-hesitant people and easing their concerns.
What an effective campaign looks like
Vaccine-hesitant people deserve the time to explore their fears with empathetic listeners, says Nadine Gartner, founder of Boost Oregon, one of the nation’s few community-based, parent-led vaccine education and advocacy organizations. (Because most anti-vaccine conspiracy theories focus on childhood immunizations, most pro-vaccine advocates focus their efforts there as well.)
Boost has a wide variety of educational resources for parents, family members, and health care workers, but the cornerstone of the organization’s work is a series of two-hour informational sessions led by pediatricians, during which parents can ask any questions or address any concerns they might have about vaccines (like most things, the seminars moved online when the pandemic began). Gartner believes the tone and length of the meetings are what makes them a success.
“I honestly think the most important factor is that we create a safe space [for parents] to express their hesitancies and receive responses that are not insulting or denigrating or judgmental,” she says. “When we’re able to break things down without a time crunch on it, it just allows us to have real conversation.”
In the lead-up to a coronavirus vaccine, the U.S. should be looking to pro-vaccine advocates and educators who have experience dialoguing with vaccine-hesitant people and easing their concerns.
Of course, few people in the United States can expect their physicians to spend that much time with them: In 2017, the average doctor visit was just 20 minutes long, and telehealth visits tend to be shorter than in-person appointments. Seminars about vaccines are also not available in every geographical location, although Boost’s are now accessible to everyone via the internet.
Beyond in-person or online seminars, there’s social media. The downsides, particularly when it comes to medical misinformation, are well-known by now, and people who speak out on behalf of evidence-based medicine and vaccines often risk harassment or worse. But there are advantages: It’s low-cost, accessible to many, and both the public and health care professionals can access it on their own time.
“If I can sit down, clear the kids out, and really spend time [engaging with] one person, I can get a whole group of people to consider vaccinating,” says Taryn Chapman, a molecular biologist who blogs at The Vaccine Mom and is a staff writer at Immunization Action Coalition. Chapman keeps her content interesting and shareable by leaning heavily on infographics she designs and adopting a relatable tone over a pedagogical one.
In “Story and Science,” an influential 2013 paper in Human Vaccines and Immunotherapeutics, authors Karen Ernst and Ashley Shelby suggested that pro-vaccine parents try to harness the “profound power of storytelling” in the way anti-vaccine advocates have. Chapman agrees.
“We need to kind of combat [their narratives] with other stories, like how the disease is worse than getting the vaccine,” she says, citing an article she wrote with Patti Wukovits, whose teenage daughter Kimberly died of meningitis B and who founded the Kimberly Coffey Foundation in her honor, as an example. In the case of the coronavirus, this might mean regularly broadcasting the obituaries of those we’ve lost over the course of the pandemic, as the New York Times does, to remind people of the potential cost of remaining unimmunized.
The pro-vaccine cohort has never developed major online influencers to the degree the anti-vaccine community has, but that should change if we want to bolster interest in public health measures. “Elevate great communicators, find some good pediatricians, find some amazing celebrity, just like if you’re building a brand or selling a sweatshirt,” says Wendy Sue Swanson, MD, a pediatrician, author, and media personality. Much like the celebrity-driven #WearADamnMask campaign or the UN’s previous Shot@Life partnership with actress Amanda Peet, a coronavirus vaccine initiative could benefit from the involvement of people with global profiles, like actors, or those with smaller but still significant reach, like community politicians or religious leaders. “It’s going to depend on people with influence in society building trust in our solutions,” Swanson says.
Another challenge for the pro-vaccine movement is creating content that is as sleek and compelling as the opposition’s. “Some anti-vaccine thought leaders are highly skilled at using misleading video content to convince people to doubt vaccines,” says Devon Greyson, PhD, a public health information scientist at the University of Massachusetts Amherst. “Public health has rarely been competitive in the video media landscape.”
In mid-April, Johnson & Johnson released The Road to a Vaccine, a web series hosted by journalist Lisa Ling and featuring interviews with leading scientists, researchers, and public health experts talking about a potential coronavirus vaccine. Currently in its second season, The Road to a Vaccine offers viewers the chance to ask questions of the expert interviewees in real time via social media. Michael Sneed, Johnson & Johnson’s executive vice president of global corporate affairs and chief communication officer, said the company felt strongly about providing the public a window into what is normally a cloistered process because the topic “touches us all.”
While the show doesn’t discuss vaccine hesitancy or health misinformation directly, Ling does address the issue briefly with Paul Stoffels, MD, the chief scientific officer of Johnson & Johnson, in the third episode of the first season. Stoffels reminds viewers of what the world has gained from vaccinations, which is easy to lose sight of considering how many people living today have gone their whole lives without encountering many once-common and devastating communicable diseases.
“There are a lot of people who are very concerned about vaccines to begin with,” Ling asks. “How can you ensure a vaccine will be safe?”
“I know very many people are scared from vaccines, but vaccines prevent today many diseases from your childhood: measles, mumps, rubella, hepatitis now,” says Stoffels. “All types of diseases are out of our life because of vaccines. Vaccines [have] been one of the most important technologies to bring our lives where we are today.”
The series exemplifies an attempt at transparency, something that will be key to engendering public trust ahead of a Covid-19 vaccine debut. Too often, anti-vaccine activists are able to cite the opaque business dealings of the pharmaceutical industry, as well as past tragedies like the thalidomide crisis (the drug was prescribed to pregnant women and caused birth defects) or the opioid epidemic, as evidence that the entirety of allopathic medicine is nefarious. Giving people increased access to and information about manufacturing practices and safety parameters will be especially important in winning over minority communities, many of whom are distrustful of health authorities because they’ve been dismissed by them in the past, or because they’ve suffered as a result of intergenerational iatrogenic trauma.
Some of the common fears people have expressed about a coronavirus vaccine, like that the general population will serve as guinea pigs, can be adequately addressed right now. (“There are tens of thousands of people lined up right now to get that vaccine in clinical trials,” Chapman says. “You don’t have to be first.”) But even the fears that can’t be tackled yet due to lack of information can still be the subject of ongoing conversations, especially if folks are forthright about what’s unknown.
“We don’t know if a safe and effective vaccine will ever become available,” says Gartner. “I believe in messaging what we know now. We know that many smart and capable people are working on it. And we do know the different steps that go into producing and approving [currently available vaccines]. My expectation is that it is going to follow the systems in place.”
There remains the question of how to appropriately target the people who will likely benefit most from a coronavirus vaccine. “We don’t have a lot of practice messaging about the importance of vaccination to the general working-age adult population,” says Greyson, “and we know that some demographics, such as men who are not primary caregivers tend to avoid health care interactions, making them challenging to reach.”
But here, too, wisdom can be borrowed from advocates in the childhood pro-vaccine space, all of whom said that even when operating as medical professionals, they always lead conversations about vaccinations with the shared experience of being a parent who just wants to protect their loved ones. Though we can’t always build bridges based on parenting, there is value in emphasizing shared experiences and gently nurture trust in our health care authorities, and in each other.